September 8--14 is National Suicide Prevention Week, an annual campaign sponsored by the American Association of Suicidology that recognizes suicide as a major public health concern and promotes the message that suicide deaths can be preventable. In the U.S. alone, nearly 40,000 people take their own lives each year. That's an average of 105 deaths per day. Yet, unlike the campaigns focused on the 9 other leading causes of death, suicide prevention isn't just about raising funds and improving treatment. Suicide is associated with stigma and misconceptions that often close the dialogue and prevent us from learning how we can overcome this epidemic. We don't talk about it. We are scared to ask about it. We simply don't know what to do.

It is undeniable that all of us are thinking about suicide. We thought about it when Hank Pym (Ant-Man) contemplated ending his life after years of stress on his constantly-morphing body. We thought about it when Roy Harper (Red Arrow) was tormented by his phantom limb pain and overdosed on painkillers. We thought about it when Bruce Banner confessed that he could no longer withstand the internal destruction caused by the Hulk, but when he put a bullet in his mouth, "the other guy spit it out." Everyone who's read Neil Gaiman's The Sandman can stand up. You've thought about it, too. Constantine. Deadshot. Mr. Terrific. Rorschach. Nearly every character in The Walking Dead. The list of narratives goes on, some more explicit than others.

Fiction is one of the most common ways we openly explore suicidality and connect with feelings of hopelessness, despair, and depression. Comics allow us to participate in the subversive in a way that is culturally acceptable. We break that rule and seem to enter a place of insecurity and isolation when we begin admitting our own feelings of anguish and thoughts of self-harm.


Misconceptions About Suicide



When actor and comedian Robin Williams died by suicide on August 11, 2014, the creative community was momentarily paralyzed. Questions poured out of us as we experienced a strange combination of feeling shocked, yet unsurprised.

What went wrong? I thought he was doing better. He didn't look depressed. I thought only those who were depressed commit suicide.

For those of us in the mental health field, these questions aren't new. We know, for instance, that people who are not clinically depressed attempt suicide (dealing with chronic pain, drug and alcohol dependence, anxiety disorders, and other mental health problems can also lead to suicidality). We know that some people take their own lives in periods of happiness. We know that people contemplate suicide in euphoric states. We also know that people die while in our care. Half of individuals who die by suicide had seen a medical doctor within the last month. Over a third of people who die by suicide had seen a mental health professional — yes, a person who should be qualified to recognize warning signs —  within the last 30 days.

If you're already feeling frustrated and confused, you should be. Every time we lose someone to suicide, I'm asked, "Why aren't officials in the mental health system doing something about this?" The truth is, they are.

In June, I was invited to Washington, D.C. to participate in something called the Zero Suicide Academy. The Academy was sponsored by the National Action Alliance for Suicide Prevention, which was launched by the U.S. Department of Health and Human Services and the Department of Defense to enhance the national infrastructure for suicide prevention. Scientists-practitioners and mental health professionals were gathered from all over the country to learn strategies and interventions that would establish more effective, "suicide-safe" health services. It was like the Hogwarts for suicide prevention, only instead of learning magic we were learning how to save lives.

The word "zero" is a firm response to a deeply held belief in our society that we cannot save everyone, that suicide "will inevitably happen."  Some even believe, "If someone wants to die, who are we to stop them?" I can understand that this question stems from a culture that values free will, individualism, choice. The problem is that the person contemplating suicide and deciding that ending their life is an option may not know about other options available to them that can also end their pain. The Bridge, a film project that explored suicide attempts at the Golden Gate Bridge revealed that the few survivors of the near-fatal fall never tried to kill themselves again. The goal of zero suicides, therefore, supports the idea that everyone who considers suicide fundamentally wants to live. Something inside of us wants to spit that bullet out.


Bringing Stories of Death to Life

From 'The Life After' by Joshua Hale Fialkov and Gabo
From 'The Life After' by Joshua Hale Fialkov and Gabo


Joshua Hale Fialkov is an Eisner, Emmy and Harvey Award nominated writer of comic books. In his and artist Gabo's story, The Life After, Fialkov explores the dimensions between life and death. Fialkov himself has wrestled with suicidal ideation (preoccupation with suicide and thoughts of wanting to die). "I suffer from constant, chronic migraines," he explains.  "I get them a couple of times a month on average...It's the very definition of suffering.  For the hours that I'm afflicted, there is no hope, there is no relief, and there is no escape.  Except..."  Fialkov spent his early years assisting his father, a psychiatrist, and seeing what he calls "the inner workings of human psychology in its darkest forms."

Janelle Asselin, writer for ComicsAlliance and former DC Comics editor, speaks openly about her struggles with depression and her history of voluntary inpatient treatment. Six months into her first serious episode of Major Depression, Asselin realized the occasional suicidal thought had intensified, becoming a "constant temptation," for weeks at a time. Luckily, she knew where to go. She admitted herself into a treatment center "rather than risk fighting alone any longer."

But thoughts of suicide never seem to go away completely. When Asselin encounters hardships, the thoughts creep in, telling her, "This would all be solved if I wasn't here" or "I cannot handle any more of anything." Asselin has learned, though, that the thoughts often end there, especially when she reminds herself to focus on "what is good" in life, and that even though things are bad now, "eventually things will get better."

Researchers have examined the relationship between suicidality and creativity. There is evidence for higher levels of creativity in persons with Bipolar Disorder, a diagnosis that raises the risk of suicide attempt. People in the creative arts are expected to have up to 3 times the rate of psychosis, suicide attempts, mood disorders and substance abuse than those in other fields.


Marbles: Mania, Depression, Michelangelo, and Me, cartoonist comic Ellen Forney
From 'Marbles: Mania, Depression, Michelangelo, and Me' by Ellen Forney


In Marbles: Mania, Depression, Michelangelo, and Me, cartoonist Ellen Forney boldly shares the ups and downs of her Bipolar Disorder. Her graphic memoir takes us through the lively, exhilarating twists and turns of her manic episodes, and the despair and fears of her depressive episodes. Terrified that her psychotropic medication would cause her to lose her creativity and livelihood, Forney looked to the stories of other artists and writers who suffered from mood disorders, seeking to understand whether she, too, can actually tolerate life with an untreated mental illness. But she was running out of options. "I was slipping down and there was nothing I could hold on to," she writes. Forney noted that suicide attempts are common among persons with Bipolar Disorder (an estimated one out of three).

During a San Diego Comic-Con interview this year, leading Batman writer Scott Snyder shared with me that he's had difficulty with anxiety and depression throughout his writing career. He noticed that he could "sense" the bad feelings build up. He would wake up some mornings and "feel a change, as if something went wrong." "It's almost like you feel tingly in a way where you know something is off and from that point forward this anxiety kicks in where you just worry...I couldn't stop thinking about how awful everything I write is."

But does the misery make the work better? "I've never truly understood that, as my afflictions make me unproductive as all hell," explains Josh Fialkov.  "But, again, the work I've created in states of joy have always outdone those done in a state of pain or depression." It doesn't have to be all or nothing.  "I've adapted, and I've found ways to get myself back to work.  If anything, I look at the work I do after bouts of depression as a triumph and as a fire that lights the way for me through that darkness."

Fialkov also reflects on the comics industry's tendency to alienate each other. The community can be reactive, defensive, constantly re-wounding itself. "I will say that we're made up of outsiders and those who are different than the norm," Fialkov says.  "Just by nature of being readers we're already a different caste of people than the mainstream.  As we grow and begin to embrace the diversity of the world around us, this is just another facet we have to face, and, I think we'll do it with aplomb."

"I think the comics community is usually fantastic at being supportive of people who are suicidal. I've met a lot of others in the industry who deal with the same issues," offers Asselin.

"With great imagination comes openness," says Dino Andrade, voice actor and teacher, known for his role as the Scarecrow in the first two installments of the Batman: Arkham Asylum video game series. Andrade lost his wife, Mary Kay Bergman, to suicide in 1999. Bergman was the beloved voice actor known for her work on South Park and animated Disney films. After her suicide, many learned that she suffered from depression. Andrade discovered an acceptance of mental illness inside the geek community. "I think that’s because we have always embraced awkwardness, shyness, etc… in all its forms.  So when someone says that there’s more to the way they are than merely social awkwardness such as clinical social anxiety, or manic-depression was are far more understanding.  Unfortunately, knowing how to help – geek or not - is still a matter of educating ourselves on what mental illness really is.  If such education were a national priority just imagine how many lives would be saved."


Loss Survivors

From 'The Sandman: Dream Country' by Neil Gaiman, Colleen Doran, Malcolm Jones III and Steve Oliff
From 'The Sandman: Dream Country' by Neil Gaiman, Colleen Doran, Malcolm Jones III and Steve Oliff


For every suicide, there are six loss survivors. That means every day there are over 600 new people in the U.S. who are suddenly and inexplicably dealing with suicidal grief. Andrade dealt not only with his own grief following Bergman's suicide, but the anger, confusion, and even blame from others. He was told that Mary Kay was "too successful to just commit suicide--something else must have been going on." In the aftermath of his incredible loss, he experienced the stigma of suicide directly.

"All of this can make a guy pretty angry," Andrade admits. "But time, the ever growing awareness of mental health issues and the kind words of those who have gone out of their way to tell me how hearing Mary Kay’s story gave them hope in their own struggles have all helped to temper those flames."

In fact, suicidal grief is considered a complex, intense, and varied experience, and can be characterized by feelings of confusion and anger. As Fialkov points out, "it's a horrible, awful thing that happens not just to the person who commits suicide, but to everyone connected to them, to everyone who loves them, and to everyone who ever could have loved them. That's the very definition of tragedy."

Professionals in the mental health field are touched by suicide on almost a constant basis. Grief related to losing patients is sometimes referred to as an "occupational hazard." There is this assumption that we are somehow magically immune to mental health troubles. I wish that were true. My friend and colleague, Dr. Ali Mattu, lost his brother, Salman Mattu, to suicide over six years ago. "Early on, I remember feeling a lot of guilt – Why didn’t I do more to help him?  What did I miss? Why wasn’t I there for him? But I kept all that to myself. I was too anxious to share my thoughts with others. I was afraid people would think of me as ‘the psychologist who let his brother die.’ I didn’t tell anyone about my brother’s death. Instead, I started to pretend I was an only child and avoided the topic of Salman all together."

"I remember reorganizing my whole apartment to take down anything that reminded me of Salman. Photos of us together, my Street Fighter action figures (our favorite video game), and my Battlestar Galactica DVDs (we used to watch, and re-watch, the show all the time) all went into storage. I avoided seeing The Dark Knight for a while because we spent the months leading up to his death talking about how awesome it was going to be. When J.J. Abrams’s Star Trek was released I cried during the prologue because I kept thinking of how much my brother would have loved seeing this."

Mattu realized the risk of erasing Salman's memory from his life. "Salman was the person who introduced me to science fiction and Star Trek is what made me want to become a psychologist. That’s why he kept coming up in all the stuff I did. My options were to either give up on the things I loved or find a way to face my fears." Mattu started by sharing what he was going through with his friends, then his close colleagues. "To my surprise, the things I was worried about, people judging me, questioning my abilities as a therapist, thinking there was something wrong with my family, never happened." Mattu admits that it wasn't easy-- in fact, it was "terrifying at times." But it got easier.

Now, a clinical psychologist at Columbia University, Mattu sees the impact of telling his story. "Writing The Parallel Universe Where My Brothers Lives changed my life. The response was overwhelming. I heard from over 3,000 people who also struggled with mental health, some who were mourning loved ones and others who’ve experienced the stigma of suicide. Any shame or guilt I felt before is gone. It’s like someone flipped a switch and I can now talk about Salman like I used to when he was alive."


Finding Support



According to the National Action Alliance for Suicide Prevention, a widespread effort to educate the public about mental health and suicide risk is pivotal to reducing deaths.

"Many people do not make the connection between suicide and mental illness," warns Andrade. "When Mary Kay killed herself, I was clueless. The guilt of not knowing if I had done something wrong and/or if I could have saved the life of my own wife was tearing me apart." Andrade sought his own therapy in order to make sense of the life lost, and the life that was falling apart. "Educating myself was where the healing began."

Dr. Ali Mattu encourages us to challenge the legacy of silence. "Why all the misconception? We don’t talk about suicide! It’s a big part of the human experience but it’s avoided in our culture. All this stigma makes it hard for people who are impacted by suicide to get the help they need. It also makes it impossible for those who haven’t experienced suicidality to understand what it must feel like."

As far as coping with thoughts of self-harm, Janelle Asselin reminds us that the brain can trick us. "Remember that depression lies, and that you are not worthless or as alone as you might feel." Josh Fialkov stresses the importance of reaching out to others for help. "The longer you sit around feeling alone, the truer it becomes.  The deeper you recede into pain, the more it becomes the norm."  He asks us to move past the idea that suicide is a sin, a crime one commits against oneself. "That's not true," he writes. "The greatest sin is not accepting the love around you."

Andrade also sheds light toward the importance of social support. "Those contemplating suicide most likely believe that no one truly understands the pain they are suffering. But many of us know exactly what you are going through and we are here to help. Just reach out."


From 'All Star Superman' by Frank Quitely, Jamie Grant and Grant Morrison
From 'All Star Superman' by Frank Quitely, Jamie Grant and Grant Morrison


If you or someone you know is suicidal, contact a mental health professional or call 1-800-273-TALK (8255).

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